Individual
INE R. SANTOSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
133 CHURCH ST., NORTHBOROUGH, MA 01532-0507
(508) 393-2318
Mailing address
PO BOX 507, 133 CHURCH ST., NORTHBOROUGH, MA 01532-0507
(508) 393-2318
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
MA 17205
MA
Other
Enumeration date
05/24/2007
Last updated
07/08/2007
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